D3.325 - Immediate-type allergic reactions associated with thiuram mix sensitization in an adolescent with atopic dermatitis: a case report

Thiuram compounds are common rubber accelerators and a frequent cause of allergic contact dermatitis mediated by delayed-type hypersensitivity. Immediate-type systemic allergic reactions following contact with thiuram-containing materials are rarely reported, particularly in pediatric patients.

We describe a case of a 15-year-old male with a history of atopic dermatitis since early childhood, which markedly improved by adolescence, with only occasional eczema on the volar aspects of the wrists. The patient was referred for allergological evaluation due to recurrent severe acute allergic reactions. Clinical history, comprehensive allergological investigations, and patch testing were performed.

The first reaction occurred while wearing a rubber carnival mask, with onset of nasal congestion, dyspnea, throat tightness, facial edema, erythema of the hands, and generalized weakness approximately 15 minutes after exposure, requiring emergency department treatment. A second severe reaction developed after sleeping in close contact with a dog, presenting with facial and hand swelling, profound weakness, and somnolence, leading to admission to the intensive care unit. Sensitization to canine prostate allergen was subsequently identified. The most recent reaction occurred during a dental procedure involving the use of medical gloves, resulting in acute perioral, facial, and hand edema with erythema shortly after exposure.

Allergological work-up revealed no sensitization to natural rubber latex. Investigations for hereditary angioedema, including C1 esterase inhibitor levels and activity and C4, were normal. Baseline serum tryptase measured outside acute reactions was within normal limits. All investigations were performed more than four weeks after the last reaction. Due to recurrent wrist eczema, patch testing with the European baseline series demonstrated a strong positive reaction to thiuram mix (+++), while all other contact allergens were negative.

This case illustrates a rare presentation of immediate-type systemic allergic reactions associated with thiuram mix sensitization in an adolescent with atopic dermatitis. It highlights the importance of considering rubber accelerators as potential triggers of acute allergic reactions, even in the absence of latex sensitization.

Written informed consent for publication of clinical details was obtained from the patient’s legal guardian.